Progressive pre-disconnection of urethral mucosal flap during transurethral plasmakinetic enucleation of prostate improves postoperative urinary continence / 浙江大学学报·医学版

OBJECTIVES@#To investigate the effect of progressive pre-disconnection of urethral mucosal flap during transurethral plasmakinetic enucleation of prostate (TUPEP) on early recovery of urinary continence.@*METHODS@#Clinical data of patients with benign prostatic hyperplasia (BPH) admitted in Zhujiang Hospital of Southern Medical University during February and May 2022 were collected. All the patients underwent TUPEP, and the progressive pre-disconnection of urethral mucosal flap was performed in the procedure. The total operation time, enucleation time, postoperative bladder irrigation time and catheter indwelling time were recorded. Urinary continence was evaluated 24 h, 1 week, and 1, 3, 6 months after the removal of urinary catheter.@*RESULTS@#All surgeries were successfully completed at one time with less intraoperative bleeding, and there were no complications such as rectal injury, bladder injury or perforation of prostate capsule. The total operation time was (62.2±6.5) min, the enucleation time was (42.8±5.2) min, the postoperative hemoglobin decrease by (9.5±4.5) g/L, the postoperative bladder irrigation time was (7.9±1.4) h, and the postoperative catheter indwelling time was 10.0 (9.2, 11.4) h. Only 2 patients (3.6%) had transient urinary incontinence within 24 h after catheter removal. No urinary incontinence occurred at 1 week, and 1, 3, 6 months after operation, and no safety pad was needed. The Qmax at 1 month after operation was 22.3 (20.6, 24.4) mL/s, international prostate symptom scores were 8.0 (7.0, 9.0), 5.0 (4.0, 6.0) and 4.0 (3.0, 4.0) at 1, 3 and 6 months after surgery, and quality of life scores at 1, 3 and 6 months after surgery were 3.0 (2.0, 3.0), 2.0 (1.0, 2.0) and 1.0 (1.0, 2.0), all of these indicators were better than those before surgery (all P<0.01).@*CONCLUSIONS@#In the treatment of BPH, the application of progressive pre-disconnection of urethral mucosal flap in TUPEP can completely remove the hyperplastic glands and promote early recovery of postoperative urinary continence with less perioperative bleeding and decreased surgical complications.

Clinical study of endoscopic surgery for recurrent nasopharyngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

Objective:To compare the clinical effects and complications of surgery + chemotherapy and radiotherapy + chemotherapy in patients with nasopharyngeal carcinoma recurrence, so as to compare the safety and efficacy of two different therapeutic methods. Methods:A retrospective analysis was performed on 40 patients with recurrent nasopharyngeal carcinoma after radiotherapy and chemotherapy admitted to our hospital from January 2016 to June 2020. Among them, 26 patients were treated with surgery. The recurrent tumor was removed under nasal endoscope, and the frozen resection margin was negative during the operation. Chemotherapy was continued for stage Ⅲ and Ⅳ patients from 3 to 5 weeks after surgery. Fourteen patients received secondary radiotherapy and chemotherapy. Postoperative complications and survival rate were observed. Results:There were 14 patients in the secondary chemoradiotherapy group（control group） and 26 patients in the nasal endoscopic surgery group（observation group）. Among the 26 patients, 19 patients underwent nasal septal mucosal repair, 5 patients underwent temporal muscle flap repair, 2 patients underwent submental flap repair, 2 patients had nasal septal mucosal flap necrosis and cerebrospinal fluid leakage, and the temporal muscle flap was used for secondary repair in the second stage operation, and 8 patients needed cervical lymph node dissection. The patients recovered well after surgery, and the patients in stage Ⅲ and Ⅳ were treated with chemotherapy after 3 weeks to 5 weeks according to the patient's wound condition. There were significant differences in the incidence of complications and 1-, 2-, and 3-year survival rates between the two groups（P<0.05）. Conclusion:Patients with recurrent nasopharyngeal carcinoma can be treated by nasal endoscopic surgery to remove the tumor, and the use of pedicled nasal septal mucosal flap or temporal muscle flap for skull base reconstruction, The operation can effectively prevent major complications such as internal carotid artery rupture and hemorrhage, and improve the survival rate and quality of life of patients. It provides a safe and effective treatment for patients with recurrent nasopharyngeal carcinoma.

Curative effect and safety of modified dacryocystorhinostomy with simple anterior flap anastomosis in the treatment of chronic dacryocystitis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the curative effect and safety of modified dacryocystorhinostomy with simple anterior flap anastomosis in the treatment of chronic dacryocystitis.<p>METHODS: A total of 99 patients(113 affected eyes)with chronic dacryocystitis who underwent dacryocystorhinostomy in the hospital between March 2016 and July 2018 were enrolled in the retrospective study. They were divided into the traditional group(traditional dacryocystorhinostomy, 46 cases, 52 affected eyes)and the modified group(modified surgery with simple anterior flap anastomosis, 53 cases, 61 affected eyes)according to the surgical procedures. The surgical results, rates of granulation tissue formation around the anastomotic stoma at different time after surgery, rates of nasal mucosal epithelialization, size of the anastomotic stoma, the occurrence of surgical complications and the recurrence rate during 1a of follow-up were compared between the two groups.<p>RESULTS: The grade of curative effect in the modified group was better than the traditional group(75.0% <i>vs </i>95.1%)during 6mo of follow-up(<i>P</i><0.05). The total cure rate was higher than that of the traditional group(<i>P</i><0.005). The rates of granulation tissue formation(3.8%, 5.7%, 9.4%)in the modified group at 1mo, 3mo and 6mo after surgery were lower than those in the traditional group(64.2% <i>vs</i> 39.1%, <i>P</i><0.001). The rate of nasal mucosal epithelialization in the modified group was higher than that in the traditional group(25.63±4.76 <i>vs </i>11.34±3.52mm2, <i>P</i><0.01)at 1mo after surgery. The area of anastomotic stoma in the modified group was larger than that in the traditional group(25.63±4.76 <i>vs </i>11.34±3.52mm2,<i>P</i><0.01)at 6mo after surgery. The incidence rates of postoperative hemorrhage and complication in the modified group and the recurrence rate in 1y of follow-up were lower than those in the traditional group(<i>P</i><0.05).<p>CONCLUSION: The cure rate of patients undergoing modified dacryocystorhinostomy with simple anterior flap anastomosis is higher than those undergoing traditional surgery. The former can promote nasal mucosal epithelialization, maintain the size of anastomotic stoma and prevent the formation of surrounding granulation tissue. It is safe and effective, with few complications and low recurrence rate.

Curative effect and safety of modified dacryocystorhinostomy with simple anterior flap anastomosis in the treatment of chronic dacryocystitis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the curative effect and safety of modified dacryocystorhinostomy with simple anterior flap anastomosis in the treatment of chronic dacryocystitis.<p>METHODS: A total of 99 patients(113 affected eyes)with chronic dacryocystitis who underwent dacryocystorhinostomy in the hospital between March 2016 and July 2018 were enrolled in the retrospective study. They were divided into the traditional group(traditional dacryocystorhinostomy, 46 cases, 52 affected eyes)and the modified group(modified surgery with simple anterior flap anastomosis, 53 cases, 61 affected eyes)according to the surgical procedures. The surgical results, rates of granulation tissue formation around the anastomotic stoma at different time after surgery, rates of nasal mucosal epithelialization, size of the anastomotic stoma, the occurrence of surgical complications and the recurrence rate during 1a of follow-up were compared between the two groups.<p>RESULTS: The grade of curative effect in the modified group was better than the traditional group(75.0% <i>vs </i>95.1%)during 6mo of follow-up(<i>P</i><0.05). The total cure rate was higher than that of the traditional group(<i>P</i><0.005). The rates of granulation tissue formation(3.8%, 5.7%, 9.4%)in the modified group at 1mo, 3mo and 6mo after surgery were lower than those in the traditional group(64.2% <i>vs</i> 39.1%, <i>P</i><0.001). The rate of nasal mucosal epithelialization in the modified group was higher than that in the traditional group(25.63±4.76 <i>vs </i>11.34±3.52mm2, <i>P</i><0.01)at 1mo after surgery. The area of anastomotic stoma in the modified group was larger than that in the traditional group(25.63±4.76 <i>vs </i>11.34±3.52mm2,<i>P</i><0.01)at 6mo after surgery. The incidence rates of postoperative hemorrhage and complication in the modified group and the recurrence rate in 1y of follow-up were lower than those in the traditional group(<i>P</i><0.05).<p>CONCLUSION: The cure rate of patients undergoing modified dacryocystorhinostomy with simple anterior flap anastomosis is higher than those undergoing traditional surgery. The former can promote nasal mucosal epithelialization, maintain the size of anastomotic stoma and prevent the formation of surrounding granulation tissue. It is safe and effective, with few complications and low recurrence rate.

Application of mucosal flap technique in Draf type Ⅱb/Ⅲ frontal sinus surgery / 中华耳鼻咽喉头颈外科杂志

Draf type Ⅱb/Ⅲ frontal sinus surgery has been widely used in clinical practice. They can obtain a wide operating space and sufficient drainage pathways. However, the mucosa around the frontal sinus ostium was removed during the surgery, resulting in bone exposure, and sinus ostium stenosis or atresia may occur after the operation. In recent years, rhinologists at home and abroad have applied various mucosal flaps to cover the exposed bone around the frontal sinus orifice after Draf Ⅱb/Ⅲ frontal sinus surgery, in order to reduce scar formation and bone hyperplasia along with the incidence of frontal sinus ostium stenosis or atresia after surgery. Satisfactory results have been achieved. The article reviews the application of mucosal flap technique in Draf Ⅱb/Ⅲ frontal sinus surgery, in order to promote the clinical research and technical development of this technique in China.

Therapeutic effect of pedicled nasal septum mucosal flap on cerebrospinal fluid leakage in transsphenoidal approach / 中国医师进修杂志

Objective To explore the therapeutic effect of pedicled nasal septum mucosal flap on high-flow cerebrospinal fluid leakage in transsphenoidal approach. Methods The clinical data of 31 patients with high-flow cerebrospinal fluid leakage during neuroendoscope transsphenoidal approach from January 2012 to April 2018 were analyzed retrospectively. Among them, skull base of 18 patients was reconstructed with pedicled nasal septum mucosal flap technique (observation group), and skull base of 13 patients was reconstructed with the'sandwich'method (control group). The postoperative cerebrospinal fluid leakage and complications were compared between 2 groups. Results Postoperative cerebrospinal fluid leakage occurred in 6 cases in control group, and 1 case in observation group, and there was statistical difference between 2 groups (P<0.05). Postoperative olfactory loss occurred in 2 cases in control group, and 3 cases in observation group, and there was no statistical difference between 2 groups (P>0.05). Conclusions Multilayer skull base reconstruction with pedicled nasal septum mucosal flap can significantly reduce the incidence of cerebrospinal fluid leakage after transsphenoidal tumor resection, and is a safe and reliable method to treat the high flow cerebrospinal fluid leakage in operation.

Application of two kinds of nasal mucosal incision in dacryocystorhinostomy under nasal endoscope / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the intraoperative bleeding and the postoperative therapeutic effect of two nasal mucosal incisions in nasal endoscopic dacryocystorhinostomy.<p>METHODS: Retrospective study. Sixty-three patients(66 eyes)with chronic dacryocystitis diagnosed by ophthalmology and treated by nasal endoscopic dacryocystorhinostomy in our hospital from June 2016 to May 2018 were collected. According to the different grouping of the base of nasal mucosal flap, dacryocystorhinostomy was performed through nasal mucosal incision with middle turbinate axilla as base in group A, and dacryocystorhinostomy was performed through nasal mucosal incision with maxillary line as base in group B. The patients were followed up to 6mo after operation, and the intraoperative bleeding and postoperative efficiency were compared between the two groups.<p>RESULTS: There was significant difference in intraoperative bleeding between the two groups.(χ²=11.803, <i>P</i><0.05). The postoperative efficiency of patients in the two groups was not statistically significant(82% <i>vs</i> 73%, <i>P</i>>0.05).<p>CONCLUSION: The nasal mucosal incision with the middle turbinate axillary region as the base was associated with more bleeding during the operation, while the nasal mucosal incision with the maxillary line as the base was less bleeding during the operation, and there was no significant difference in the postoperative treatment effect.

Observation of effect of red lip defect repair using orbicularis oris muscles pedicle island flap disc / 中国基层医药

Objective To explore the effect of red lip defect repair using orbicularis oris muscles pedicle island flap disc.Methods 100 cases of unilateral pure red lip defect 1/3-2/3,lip lines full of patients were selected as the research subjects.They were randomly divided into two groups,50 cases in each group.Group A treated with debridement surgery to repair.Group B received red lip flap to promote repair treatment.The treatment effect of the two groups, satisfaction, lip survival rate and the degree of obvious scars were compared.Results he operation effect of the two groups was good.The satisfaction rates of group A and group B were 94.00% and 96.00%,respectively.For the lip shape treatment satisfaction, the difference was no statistically significant (P>0.05).The patients of the two groups with lip all alive, and 1 patient in group A with obvious scar, the scar was not obvious in group B.Conclusion For patients with red lip defect, take orbicularis oris muscles pedicle island flap of the oral mucosa or red lip flap to promote repair treatment has relatively significant clinical efficacy, with easy operation, less influence on the patients with facial form, it is worthy of popularizing.

Tongue flap combined with local mucosal flap for repairing palate fistulae / 中华医学美学美容杂志

Objective To introduce a modified surgical technique for repairing palate fistulae.Methods Based on the clinical categories of palate fistulae,local mucosal flap was designed,if possible,to reduce the area of the fistulae and reshape the fistulae.Then the thin tongue flap with anterior pedicle was designed for repairing the palate fistulae,without much limitation of tongue movement and excessive tension of tongue flap pedicle short lingual frenulum correction was performed firstly to release the motion of tongue,if necessary.The donor site was closed directly.Three weeks later division of the tongue flap,as well as detailed appearance correction of tongue,was carried out at the same time.Results 12 cases were treated,and followed up for 6-12 months.For all the cases,the defect of fistulae was totally repaired,while aesthetics appearance of tongue was satisfactory,and no interference with speech with the use of tongue as donor site.Oral hygiene and mastication were unimpaired.No patient described disability of sensory or gustatory postoperatively.Conclusions Tongue flap has sufficient blood supply,while impairment of donor site is minimal.The planning and procedure of surgery are relatively simple.It is an ideal flap in treatment of palate fistulae.

Clinical study on the effect of nasal mucosal flap preservation on the curative effect of endoscopic dacryocystorhinostomy / 中国医学装备

Objective: To study the effects of nasal mucosal flap preservation on the curative effect of endoscopic dacryocystorhinostomy. Methods:Chronic dacryocystitis patients received endoscopic dacryocystorhinostomy in our hospital were enrolled and randomly divided into observation group given nasal mucosal flap preservation and control group not given nasal mucosal flap preservation. Then surgery condition, psychological stress and survival quality were observed. Results: (1)successful rate of observation group(96%) was higher than control group; (2)HAMA, HAMD, SAS, SDS score of observation group were lower than control group; self realization, health responsibility, movement, nutrition, interpersonal relationships, coping scores were higher than control group. Conclusion: Nasal mucosal flap preservation is helpful to improve the success rate of endoscopic dacryocystorhinostomy and can alleviate the psychological stress, improve the quality of life in long-term follow-up.

Results of Endonasal Dacryocystorhinostomy with Lacrimal Sac Flap and Silastic Sheet

PURPOSE: To investigate postoperative outcomes of endonasal dacryocystorhinostomy (DCR) using lacrimal sac flap and silastic sheet in patients with acquired nasolacrimal duct obstruction. METHODS: From November 2009 until December 2010, endonasal DCR with lacrimal sac flap was performed in 26 eyes (group 1) and conventional DCR without flap in 28 eyes (group 2). The anatomic and functional success rates and complications were analyzed and compared between the 2 groups. RESULTS: The anatomical success rate was 96.2% in group 1 and 85.7% in group 2. The functional success rate was 100% in group 1 and 92.9% in group 2. The success rate was higher in group 1 than in group 2, although not being statistically significant. Granuloma was found in 15.4% of patients in group 1 and 32.1% of patients in group 2. Synechia or membranous obstruction was not found in group 1, whereas synechia developed in 14.3% of patients in group 2. CONCLUSIONS: Endonasal DCR with lacrimal sac flap showed a greater success rate and lower formation of granuloma than conventional endonasal DCR without flap because of reduced inflammation and granulation tissue formation around retained bony spicles.

Preliminary study of preventive measures of anterior palatal fistula after operation of cleft palate / 中国医师进修杂志

Objective To discuss the preventive measures of anterior palatal fistula by modified the operation of cleft palate. Methods For 23 patients of complete cleft palate with alveolar ridge cleft, bilateral mucoperiosteum flap was moved forward as possible so as to close fistula front of hard palate, and incised junction of the hard and soft palate to prolong soft palate and the wound was repaired by buccal mucosal flap.The incidence of anterior palatal fistula and velopharyngeal closure after operation was observed. Results Twenty-three patients were rechecked 1 month after operation ,there was no anterior palatal fistula occurring,10 cases were examined by epipharyngoscope 1 year after operation,the velopharyngeal closure was 90%-100%. Six cases were followed up for 6 months,the velopharyngeal closure was 80%-85%. Conclusions For second-stage operation methods of anterior palatal fistula, there are too many discussions of selection criterias, advantages and disadvantages. If first-stage operation is taken measures to prevent anterior palatal fistula or decrease the diameter of fistula as possible. It reduces percentage of second-stage operation or decreases the difficulty. It should get more attention in the clinical works.

The Application of Paries Anterior Vagina Muscularis Mucosal Flap in the Repairat/on of Female Complicated Urethrovaginal Fistula / 医学研究杂志

Objective To explore the application of the paries anterior vagina U shape muscularis mucosal flap for the repairing of female complicated urethrovaginal fistula. Methods Fifteen complicated urethrovaginal fistulas patients resulted from severe pelvic frac-ture and with history of failing repairing urethrovaginal fistulas were analyzed retrospectively. The mean diameter of maximum urethrovagi-nal fistula was approximately 2.3 cm. The parias anterior vagina U shape mucosal flaps were used to repair the urethrovaginal fistulas, and the paries anterior vagina muscularis mucosae were used to cover the fistulas surface again. Results Fifteen patients were followed up for 6 to 80 months, and they gained normal voiding, with no urine leakage, urinary incontinence and urethra] stricture occurring. Conclusion The paries anterior vagina U shape mucosal flap is an effective technique for repairing complicated urethrovaginal fistula.

Application of the displacement of the ventricular bands-epiglottis mucosalflap in the surgical management of glottis carcinoma / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the plastic method of glottis carcinoma in surgery. Method:Retrospectly analyzed 29 patients with T_2 ,T_3 glottis carcinoma who admited in our department From 1996 to 2004. All of them were treated with the displacement of ventricular bands-epiglottis mucosal flap in the surgical management of glot-tis carcinoma. The tumour was primarily from vocal cords, and not exceeded 2cm. Result: All cases were success-fully renovated laryngeal cavity with the displacement of ventricular bands-epiglottis mucosal flap and followed up for 5 years after operation. Three years survival rate was 86.2% ,5 years survival rate was 78.9% ,and tube draw-ing rate was 100%. Conclusion: With this method, surgery would be simplified and the patients would keep the voiced function and swallowing function.

The Application of Paries Anterior Vagina Muscularis Mucosal Flap in the Repairation of Female Complicated Urethrovaginal Fistula / 医学研究杂志

Objective To explore the application of the paries anterior vagina U shape muscularis mucosal flap for the repairing of female complicated urethrovaginal fistula.Methods Fifteen complicated urethrovaginal fistulas patients resulted from severe pelvic fracture and with history of failing repairing urethrovaginal fistulas were analyzed retrospectively.The mean diameter of maximum urethrovaginal fistula was approximately 2.3 cm.The paries anterior vagina U shape mucosal flaps were used to repair the urethrovaginal fistulas,and the paries anterior vagina muscularis mucosae were used to cover the fistulas surface again.Results Fifteen patients were followed up for 6 to 80 months,and they gained normal voiding,with no urine leakage,urinary incontinence and urethral stricture occurring.Conclusion The paries anterior vagina U shape mucosal flap is an effective technique for repairing complicated urethrovaginal fistula.

Fabrication of myomucosal flap using cultured oral epithelium in rabbit model

The Surgical Efficacy of External Lacrimal Surgery without Nasal Mucosal Flap

PURPOSE: To evaluate the surgical result of lacrimal surgery with total removal of the nasal mucosal flap. METHODS: Lacrimal surgery was performed in 30 eyes of 26 patients, by external approach without the nasal mucosal flap from February 2001 to August 2002. The surgical method was similar to conventional dacryocystorhinostomy, but the nasal mucosa of the osteotomy site was removed with a No.11 Bard-Parker blade and Westcott scissors. After insertion of a silicone tube, the anterior flap of the lacrimal sac was sutured to the soft tissues around the osteotomy site. Surgical efficacy was evaluated after a follow-up period of 7 22 months (average, 11.5 months). RESULTS: The primary success rate was 96.7% (29/30 eyes). We performed revision of mucosa ostium in the one failed eye, thereby raising the final success rate to 100%. The size of mucosa ostium was 0.7 3.0 mm (average 1.17 mm). CONCLUSIONS: Satisfactory surgical results were obtained without anastomosis of the lacrimal sac or the nasal mucosa during external approach, lacrimal surgery. We suggest that this method is a good surgical procedure in external approach, lacrimal surgery.